Exotic TravelIs it for you?

The past 20 years have seen a great increase in travel to 'exotic' destinations. People of all ages are going to places where formerly only the most adventurous dared to go. Even families with young children are travelling to almost every part of the world.

Are you one of the thousands of Canadians planning a trip to a tropical or developing country this year? If so, you will want to find out what the health risks are well before your departure so you have enough time to prepare. And if you are afraid exotic travel isn't worth the risk, read on. You may be pleasantly surprised. You will find that common sense goes a long way in preventing health problems. Beyond that, consultation with a specialist in travel health will fill the gaps.

Rating Your Risk

To help you assess your health risks we have prepared a quick quiz. Answer the questions and add up your score. Refer to Table 1 to estimate your risk. Then read further about how to prevent the two most common risks; traveller's diarrhea and malaria.

Common Health Risks

Traveller's Diarrhea (TD)

Montezuma's revenge, Delhi belly, Trotsky trots. The name changes around the world but the symptoms are the same; diarrhea with cramps, nausea and feeling unwell. TD is usually caused by germs (bacteria, parasites or viruses) which have contaminated your food, water or fingers. Even a change in the environment can cause mild diarrhea.

Poor sanitation and unclean food handling make TD the most common ailment for travellers to developing countries. Luckily, the illness is usually mild and clears up on its own within a few days. The most important treatment is replacing lost fluids and electrolytes by drinking lots of fluids.

Prevention
The best 'treatment' is prevention through safe food and water choices (see table). These precautions will also protect you from more serious food and water diseases such as hepatitis A, typhoid fever and cholera.

Vaccines are available against hepatitis A and typhoid but they are not a substitute for safe food and water choices. Cholera vaccine is no longer recommended because it is only 50 per cent effective at best. Fortunately, very few travellers on short trips (under one month) get any of these serious diseases.

Malaria

Malaria is caused by a parasite. It is passed to people by the bite of an infected mosquito, the Anopheles. Since one bite is enough to cause disease, malaria is a risk even to short-term travellers in a risk area. The Anopheles is stealthy. She bites only at night, makes no noise and delivers her bite along with a local anesthetic so it won't be felt. Symptoms of malaria resemble the flu and include fever, chills and muscle aches. Diarrhea and vomiting sometimes occur.

Malaria is a leading causes of death in the developing world. Figure 1 shows the areas where malaria is found. Risk is greater at low altitudes, during rainy seasons and in rural areas. Most major cities in Southeast Asia and South and Central America are malaria free. In places such as India, Pakistan and the sub-Saharan Africa, risk exists almost everywhere.

Prevention
There is no vaccine against malaria. It is very important, therefore, to protect yourself from being bitten (see above). Travellers visiting infected areas should also take anti-malarial drugs.

The usual drugs are taken once a week, starting one to two weeks before travel. They are continued weekly during the trip and for four weeks after leaving the risk area. Different drugs work in different areas. Some anti-malarials are not safe for small children. When there is no safe drug, it is better not to take children to malarial areas.

Anti-malaria drugs help prevent malaria but they are not 100 per cent effective. See a doctor immediately if you develop an unexplained fever even up to three years after returning home. Tell the doctor you have been in a malarial area and ask for a blood test for malaria. Malaria can be treated when it is diagnosed promptly.

Injuries: The Forgotten Risk

Though not in the category of 'exotic' risks, injuries are one of the biggest threats while travelling. Motor vehicle accidents are the most common cause of both injury and death. Learn the rules of driving, walking and cycling in the country you visit. These can be very different from home and may even appear non-existent! Use seatbelts, if provided, and avoid driving after dark.

Swim in safe areas and never swim alone. Check out fire exits in hotels and lock your hotel room at all times. Avoid the beach at night, and steer clear of areas where drug related or political violence may occur.

In many countries, emergency medical care is not readily available. It is wise to carry some basic first aid supplies with you.

Other Risks

Routine Vaccines:

Tetanus and diphtheria:
Boost every 10 years.
Measles: One dose of live vaccine or history of diseasePolio:
Boost every 10 years if going to Africa,
anywhere in Asia (except Japan) and some eastern European countries.Yellow Fever:
May be recommended or required for entry.

For the short-term traveller, there are few other health risks. Yellow fever (another mosquito-borne disease) is found in Central and South America and sub-Saharan Africa. Vaccination is required for travel to some of these countries, even if you are just passing through. Yellow fever disease is almost unheard of in immunized travellers. Long term and adventure travellers will encounter other risks and will need further information.

As at home, all travellers need to be very cautious about sexual contact with anyone other than their spouse/partner. If you anticipate meeting the partner of your dreams abroad, make sure you are protected. Carry latex condoms as they may not be easily available in some parts of the world. Asia and Africa have particularly high rates of Hepatitis B, a sexually transmitted disease which, like HIV, can be passed from mother to child during pregnancy.

Immunization and Information

It would be wise to discuss travel plans with your family doctor in the earliest stages of preparation. This will allow for immunization for Hep A and Hep B if necessary. An excellent source of advice about travel and immunization is a travel clinic. Travel clinics are usually part of the public health services offered in both cities and rural areas. Most vaccines can be completed within four to six weeks. Long-term travellers may need to start immunization six months before departure.

We hope you have left yourself enough time to get all the information and immunization you need before travel.